title: On the treatment of new oral anticoagulant-associated gastrointestinal hemorrhage.
abstract: The recently introduced new oral anticoagulants (nOAC) carry a higher gastrointestinal bleeding risk compared to traditional antithrombotic therapy. Current diagnostic coagulation tests are not accurate enough to determine the level of coagulopathy. Besides that, the lack of a specific antidote leaves the endoscopist unsure how to achieve hemostasis during gastrointestinal hemorrhage. In this brief report, we address the (endoscopic) management, when facing a suspected nOAC-associated gastrointestinal hemorrhage. We recommend that specific coagulation tests such as diluted thrombin time and anti-Xa measurement should be made available. Furthermore, nOAC should be stopped. Finally, correcting coagulopathy with administration of prothrombin complex concentrate, recombinant factor VIIa and even hemodialysis should be considered, whereas fresh frozen plasma and vitamin K have no place. The generalizability of these recommendations needs to be confirmed in future studies.
authors.affiliation: Department of Gastroenterology and Hepatology, Erasmus MC University Medical Center, Rotterdam, The Netherlands. i.holster@erasmusmc.nl
authors.forename: I Lisanne
authors.initials: IL
authors.lastname: Holster
authors.forename: Nicole G M
authors.initials: NG
authors.lastname: Hunfeld
authors.forename: Ernst J
authors.initials: EJ
authors.lastname: Kuipers
authors.forename: Marieke J H A
authors.initials: MJ
authors.lastname: Kruip
authors.forename: Eric T T L
authors.initials: ET
authors.lastname: Tjwa
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D001777:Blood Coagulation / Q000187:drug effects*; D001780:Blood Coagulation Tests; D003029:Coagulants / Q000008:administration & dosage; D006471:Gastrointestinal Hemorrhage / Q000139:chemically induced / Q000175:diagnosis / Q000628:therapy*; D016558:Hemostasis, Endoscopic; D006801:Humans; D011237:Predictive Value of Tests; D006435:Renal Dialysis; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D003029:Coagulants